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Get and Sign Nyc Eip Session Note Writable Version 1 Form 2013

Get and Sign Nyc Eip Session Note Writable Version 1 Form 2013

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__________________ AM PM Time: From _______________ AM PM To __________________ AM PM Date Note Written: ____/____/____ ICD-9 code: ______________________________ Date Note Written: ____/____/____ ICD-9 code: ______________________________ HCPCS Code (if applicable):____________________ 1st CPT Code: ______________ HCPCS Code (if applicable):____________________ 1st CPT Code: ______________ 2nd CPT Code: _________ 3rd CPT Code: __________ 4th CPT Code: _________ 2nd CPT Code: _________ 3rd CPT...
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